Definition
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, arising from hepatocytes. It is more common in individuals with chronic liver disease, such as cirrhosis and chronic hepatitis.
Pathogenesis
HCC develops from long-term liver damage caused by:
- Viral infections: Chronic hepatitis B and C.
- Alcoholic liver disease: Chronic alcohol consumption is a major risk factor.
- Non-alcoholic steatohepatitis (NASH): Associated with obesity and diabetes.
- Toxins: Such as aflatoxins from contaminated food.
Chronic inflammation and fibrosis lead to cellular mutations, causing malignancy.
Diagnosis
Diagnosis is based on:
- Imaging: Ultrasound, CT, or MRI with contrast to reveal HCC characteristics.
- Laboratory markers: Elevated alpha-fetoprotein (AFP) levels.
- Liver biopsy: Used for unclear findings.
Treatment
Treatment depends on cancer stage and liver function:
- Surgical resection: For patients with good liver function and localized disease.
- Liver transplantation: Offers a cure for suitable candidates with cirrhosis and limited cancer.
- Interventional therapies: Such as transarterial chemoembolization (TACE) for unresectable cases.
- Targeted and immunotherapies: Drugs like sorafenib and atezolizumab for advanced stages.
Prevention
Prevention includes vaccination for hepatitis B, treatment of chronic hepatitis B and C, avoiding excessive alcohol consumption, and managing risk factors for NASH. Regular ultrasound and AFP monitoring are recommended for cirrhosis or chronic liver disease patients.
Early diagnosis and individualized therapy are critical for patient survival.